Different Behavior-Change Messaging Techniques Do Not Increase Customers' Hand Sanitization Adherence During the COVID-19 Pandemic: A Natural Behavioral Study.

Introduction: Hand hygiene is an integral public health strategy in reducing the transmission of COVID-19, yet the past research has shown hand hygiene practices among the public is sub-optimal. This study aimed to (1) quantify hand sanitization rates among the public to minimize the transmission of COVID-19 and (2) evaluate whether different public health messaging, based on various behavior-change theories influences hand hygiene behavior in a natural setting. Methods: An observational, naturalistic study design was used with real-time customer activity data recorded against hand sanitizer usage in a regional hardware store. Primary outcome from the study was to measure the usage ratio by counting the amount of activity versus usage of hand sanitizer per hour against individual messages based on their behavioral change technique (BCT). Results: There was no significant difference between the baseline message and any of the intervention messages [F(16,904) = 1.19, p = 0.279] or between BCT groups [F(3,906) = 1.33, p = 0.263]. Post hoc tests showed no significant difference between messages (social comparison, p = 0.395; information, p = 1.00; and action planning, p = 1.00). Conclusion: This study showed that even during a pandemic, hand hygiene usage rates in a public setting were similar to the past studies and that compliance did not shift dependent on the public message displayed. This raises questions on whether requirements imposed on businesses to provide hand sanitizer to patrons are an ineffective and maybe an unnecessary economic burden. A measured approach to risk and behavioral analysis surrounding the use of hand sanitizer in a pandemic is suggested as a better approach to inform public policy on the value of hand sanitizer.

Do Parent-Child Dyads with Excessive Body Mass Differ from Dyads with Normal Body Mass in Perceptions of Obesogenic Environment?

BACKGROUND: This study addressed differences between parent-child dyads with excessive body mass (overweight or obesity) and dyads with normal body mass in obesity determinants, derived from social-ecological models. It was hypothesized that parents and their 5-11 years-old children with excessive body mass would (1) report lower availability of healthy food at home, (2) perceive fewer school/local community healthy eating promotion programs, (3) report lower persuasive value of food advertising. METHODS: Data were collected twice (T1, baseline; T2, 10-month follow-up), including n = 129 parent-child dyads with excessive body mass and n = 377 parent-child dyads with normal body mass. Self-reported data were collected from parents and children; with body weight and height assessed objectively. General linear models (including analysis of variance with repeated measures) were performed to test the hypotheses. RESULTS: Compared to dyads with normal body mass, dyads of parents and children with excessive body mass perceived lower availability of healthy food at home and fewer healthy eating promotion programs at school/local community (T1 and T2). These effects remained significant after controlling for sociodemographic variables. No significant differences in persuasive value of food advertising were found. CONCLUSIONS: Perceptions of availability of healthy food at home and healthy nutrition promotion may be relatively low in parent-child dyads with excessive weight which, in turn, may constitute a risk factor for maintenance of obesity.

Social support and self-care outcomes in adults with diabetes: The mediating effects of self-efficacy and diabetes distress. Results of the second diabetes MILES - Australia (MILES-2) study.

AIMS: Diabetes self-care outcomes are positively impacted by social support. Understanding the mechanisms involved can inform more effective interventions. This study tested potential cross-sectional mediation of social support through self-efficacy and diabetes distress for self-care and clinical outcomes (diet, physical activity, blood glucose monitoring, HbA1c). METHOD: We analysed a sub-sample of the Australian Diabetes MILES-2 cross-sectional online survey (N = 1727). Measures were: Diabetes Social Support Scale, Confidence in Diabetes Self-care Scale, Problem Areas In Diabetes scale, diet and physical activity subscales of the Summary of Diabetes Self-Care Activities, and self-reported HbA1c. Separate mediation path models were tested for each of the four self-care/clinical outcomes in groups with type 1 and type 2 (insulin- and non-insulin-treated) diabetes. RESULTS: Social support was associated with more optimal self-care and self-reported HbA1c outcomes. When diabetes-specific self-efficacy and distress were included as mediators, the direct path from social support became non-significant. Conversely, the indirect effects of social support through diabetes-specific self-efficacy and distress were significant across all diabetes groups and outcomes. CONCLUSION: Diabetes-specific self-efficacy and distress may be important mechanisms linking social support with diabetes self-care and clinical outcomes. Social support interventions could explore whether improving diabetes self-efficacy and decreasing diabetes distress could help improve self-care.

Parental Depression Predicts Child Body Mass via Parental Support Provision, Child Support Receipt, and Child Physical Activity: Findings From Parent/Caregiver-Child Dyads.

OBJECTIVE: Although there is substantial evidence corroborating the within-individual associations between depression, social support, moderate-to-vigorous physical activity (MVPA), and body mass, much less is known about across-individual associations. This study investigated the indirect associations between parental depression and objectively measured body mass in children. In particular, it was hypothesized that higher levels of parental depression (measured at Time 1, T1) would explain higher levels of child body mass in children (assessed at Time 2, T2), via three mediators, namely parental reports of provision of MVPA support (T1), child reports of receipt of MVPA support (T1), and child MVPA (T2). DESIGN: Parent-child dyads provided self-reports twice, at baseline (T1) and 7- to 8-month follow-up (T2). A total of 879 dyads were enrolled (1,758 individuals; 5- to 11-year-old children, 52.4% girls, 83.2% mothers). Body weight and height were measured objectively. Manifest path analyses were performed to test the indirect effects. RESULTS: Analyses corroborated the assumed indirect effects: high levels of depression in parents (T1) were indirectly associated with high levels of body mass in children (T2), via three mediators: low levels of parental support provision (T1), low levels of child support receipt (T1), and low levels of child MVPA (T2). The alternative models assuming that either parental support provision or child support receipt can be excluded as the mediators yelded a poor model-data fit. The hypothesized mediation effects were corroborated when controlling for the baseline levels of parental and child MVPA and body mass. CONCLUSION: The findings confirm complex across-individual effects of parental depression on high levels of body mass in children. Parental mental health may contribute to the childhood obesity epidemic.

Body areas satisfaction and body mass in adolescents: mediating effects of actual-ideal body weight discrepancies.

PURPOSE: This study aims at investigating prospective associations between body areas satisfaction (BAS), actual (objectively measured)-ideal body weight discrepancy, actual (self-reported)-ideal body weight discrepancy and BMI among adolescents from the general population. METHODS: Data were collected at three measurement points: baseline (T1), 2-month follow-up (T2), 13-month follow-up (T3) among 1011 adolescents (59.3% girls) aged 13-19 years (M = 16.30, SD = 0.82) with BMIs ranging from 15.20 to 38.78 (M = 20.01, SD = 3.33). Adolescents completed questionnaires regarding BAS (T1), actual and ideal body weight (T2). Body weight and height were measured objectively (T1 and T3). RESULTS: Adolescents satisfied with most areas of their bodies had lower levels of actual (objectively measured)-ideal body weight discrepancy, which in turn predicted higher BMI, while lower levels of actual (self-reported)-ideal body weight discrepancy predicted lower BMI. No moderating effect of gender was found. CONCLUSIONS: Actual-ideal weight discrepancies may operate in complex manner prompting opposite effects on BMI. LEVEL OF EVIDENCE: Level III, longitudinal study without control group.

Body satisfaction and body weight in under- and healthy-weight adolescents: mediating effects of restrictive dieting, healthy and unhealthy food intake.

PURPOSE: Theoretical models, such as the transdiagnostic model of eating disorders highlight the role of cognitive factors (e.g., the way people perceive their bodies) and their associations with maladaptive weight management behaviors resulting in underweight. This paper aims at testing the indirect association of adolescent's body satisfaction and body mass index (BMI) through restrictive dieting, healthy eating or unhealthy eating as well as moderating role of adolescent's weight status. METHODS: The study was conducted in 16 public middle and high schools in Central and Eastern Poland. A sample of 1042 under- and healthy-weight white adolescents aged 13-20 (BMI: 12.63-24.89) completed two self-reported questionnaires (fruit, vegetable, and energy-dense food intake) with a 11-month interval. Weight and height were measured objectively. Multiple mediation analysis and moderated multiple mediation analysis were conducted to test the study hypotheses. RESULTS: Adolescents less satisfied with their bodies were more likely to diet restrictively and at the same time ate more unhealthy energy-dense food rather than healthy food, which in turn predicted lower BMI. No moderating effects of weight status were found. CONCLUSIONS: Low body satisfaction is a risk for restrictive diet and unhealthy food intake. Prevention programs may target under- and healthy-weight adolescents who are highly dissatisfied with their bodies, have a high intake of energy-dense food and apply a restrictive diet at the same time. LEVEL OF EVIDENCE: Level III: longitudinal cohort study.

Associations of parental and child food and exercise aversion with child food intake and physical activity.

OBJECTIVE: The interplay between parental and child food and physical activity aversion, briefly defined as fear or avoidance of novelty or breaking from routine, may explain such child behaviors as inadequate food consumption and physical activity. Two studies were conducted to investigate the associations between child and parental food and physical activity aversion (child self-reported aversion, parental-reported aversion, and parental perceptions of child aversion) and child food intake and physical activity. METHOD: Parent-child dyads participated in 2 longitudinal studies. Study 1 (food aversion; the baseline [T1] and the 10-month follow-up [T2]) enrolled 924 dyads (1,848 individuals; 54.3% girls, aged 5-11 years old, 88.9% mothers). Study 2 (physical activity aversion; the baseline [T1] and the 7- to 8-month follow-up [T2]) enrolled 879 dyads (1,758 individuals; 52.4% girls, aged 5-11 years old, 83.2% mothers). There was no overlap between the samples enrolled in the two studies. Dyads completed self-report measures; child and parental body weight and height (for calculation of body mass index [BMI] as covariates/potential moderators) were measured objectively. Mediation analyses with 2 sequential mediators were performed. RESULTS: The association between self-reported parental food aversion (T1) and child fruit and vegetable intake (T2) was mediated sequentially by parental perception of child food aversion (T1) and self-reported child food aversion (T2). The same pattern of associations was found for physical activity aversion. Child BMI did not moderate the hypothesized associations. CONCLUSIONS: High levels of parental and child aversion operated sequentially in explaining lower levels of child fruit and vegetable intake and physical activity. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Why are you eating, mom? Maternal emotional, restrained, and external eating explaining children's eating styles.

This study investigated if three maternal eating styles (emotional eating style, external eating style, and restrained eating style) predict respective eating styles in children. In particular, we tested if these associations are different in mother-daughter dyads, compared to mother-son dyads. Data were collected twice, at the baseline (Time 1; T1) and at the 10-month follow-up (Time 2; T2), with N = 822 mother-child dyads participating at T1. Children (55% girls, 5-12 years old, M = 8.21, SD = 1.40) were interviewed; mothers (aged 23-59 years old, M = 35.93, SD = 5.24) completed the questionnaire assessing their eating styles. Participants' weight and height were measured objectively. Path analysis, accounting for dyadic interdependency and autocorrelations, was applied. In mother-daughter dyads, maternal emotional eating (T1) predicted daughters' emotional eating (T2) whereas maternal restrained eating (T1) predicted daughters' restrained eating (T2). There were no effects of external eating in mother-daughter dyads. A different pattern of associations was found for mother-son dyads, with maternal emotional eating (T1) and external eating (T1) predicting sons' emotional eating (T2) and external eating (T2), respectively. There was no effect of maternal restrained eating in mother-son dyads. Maternal eating styles explain child's eating styles with distinct effects depending on child's sex. Educating mothers about the effects of their own eating styles on daughters' and sons' eating styles might be useful to promote adequate responses to hunger and satiety signals.

Gender-Specific Body Areas Satisfaction and Body Weight Status in Adolescents: Mediating Effects of Physical Activity, Fruit and Vegetable Intake, and Energy-Dense Food Intake.

BACKGROUND: Body satisfaction is one of the key modifiable cognitive determinants of eating behaviours, physical activity, and body mass index (BMI). As the sociocultural models suggest, low body satisfaction may explain unhealthy eating and exercise behaviours. Importantly, body satisfaction levels and body areas that individuals focus on vary across genders. This study aims at investigating links between the global index of body areas satisfaction (BAS), gender-specific BAS, fruit and vegetable (F&V) intake, energy-dense foods intake, moderate-to-vigorous physical activity (MVPA), and BMI. METHODS: In all, 1,254 adolescents completed questionnaires and had their weight and height objectively measured with 2- and 13-month follow-ups. Indirect effects of three indices of BAS were tested in three models (male-specific BAS amongst boys; female-specific BAS amongst girls; the global BAS index in the total sample). RESULTS: Higher levels of all three BAS indices indirectly predicted lower BMI, with higher MVPA mediating this effect. In addition, higher energy-dense foods intake mediated higher global BAS-higher BMI relationship in the total sample. Thus, the global index of BAS acts as double-edged sword, predicting both higher MVPA and energy-dense foods intake. CONCLUSION: BAS may operate in a complex manner, predicting behaviours which may have opposite effects on BMI.

Interventions for acute stroke management in Africa: a systematic review of the evidence.

BACKGROUND: The past decades have witnessed a rapid evolution of research on evidence-based acute stroke care interventions worldwide. Nonetheless, the evidence-to-practice gap in acute stroke care remains variable with slow and inconsistent uptake in low-middle income countries (LMICs). This review aims to identify and compare evidence-based acute stroke management interventions with alternative care on overall patient mortality and morbidity outcomes, functional independence, and length of hospital stay across Africa. METHODS: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. An electronic search was conducted in six databases comprising MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Academic Search Complete and Cochrane Library for experimental and non-experimental studies. Eligible studies were abstracted into evidence tables and their methodological quality appraised using the Joanna Briggs Institute checklist. Data were analysed and presented narratively with reference to observed differences in patient outcomes, reporting p values and confidence intervals for any possible relationship. RESULTS: Initially, 1896 articles were identified and 37 fully screened. Four non-experimental studies (three cohort and one case series studies) were included in the final review. One study focused on the clinical efficacy of a stroke unit whilst the remaining three reported on thrombolytic therapy. The results demonstrated a reduction in patient deaths attributed to stroke unit care and thrombolytic therapy. Thrombolytic therapy was also associated with reductions in symptomatic intracerebral haemorrhage (SICH). However, the limited eligible studies and methodological limitations compromised definitive conclusions on the extent of and level of efficacy of evidence-based acute stroke care interventions across Africa. CONCLUSION: Evidence from this review confirms the widespread assertion of low applicability and uptake of evidence-based acute stroke care in LMICs. Despite the limited eligible studies, the overall positive patient outcomes following such interventions demonstrate the applicability and value of evidence-based acute stroke care interventions in Africa. Health policy attention is thus required to ensure widespread applicability of such interventions for improved patients' outcomes. The review findings also emphasises the need for further research to unravel the reasons for low uptake. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016051566.

Barriers to evidence-based acute stroke care in Ghana: a qualitative study on the perspectives of stroke care professionals.

OBJECTIVE: Despite major advances in research on acute stroke care interventions, relatively few stroke patients benefit from evidence-based care due to multiple barriers. Yet current evidence of such barriers is predominantly from high-income countries. This study seeks to understand stroke care professionals' views on the barriers which hinder the provision of optimal acute stroke care in Ghanaian hospital settings. DESIGN: A qualitative approach using semistructured interviews. Both thematic and grounded theory approaches were used to analyse and interpret the data through a synthesis of preidentified and emergent themes. SETTING: A multisite study, conducted in six major referral acute hospital settings (three teaching and three non-teaching regional hospitals) in Ghana. PARTICIPANTS: A total of 40 participants comprising neurologists, emergency physician specialists, non-specialist medical doctors, nurses, physiotherapists, clinical psychologists and a dietitian. RESULTS: Four key barriers and 12 subthemes of barriers were identified. These include barriers at the patient (financial constraints, delays, sociocultural or religious practices, discharge against medical advice, denial of stroke), health system (inadequate medical facilities, lack of stroke care protocol, limited staff numbers, inadequate staff development opportunities), health professionals (poor collaboration, limited knowledge of stroke care interventions) and broader national health policy (lack of political will) levels. Perceived barriers varied across health professional disciplines and hospitals. CONCLUSION: Barriers from low/middle-income countries differ substantially from those in high-income countries. For evidence-based acute stroke care in low/middle-income countries such as Ghana, health policy-makers and hospital managers need to consider the contrasts and uniqueness in these barriers in designing quality improvement interventions to optimise patient outcomes.

Does the social gradient remain in the dietary habits of a health-conscious population? A study of Seventh-Day Adventists in West Malaysia.

Background: Socioeconomic status (SES) is a strong predictor of health, and individuals with higher SES generally have better health than those with lower SES. One of the pathways that SES influences health is through health behaviors, such as dietary intake, and a higher SES has been associated with a better diet. The purpose of this study was to determine whether there was a social gradient in dietary habits among the Seventh-Day Adventists, a group of conservative Christians, where healthy eating is part of the doctrinal teaching. Methods: Data from a survey of 574 Adventists residing in West Malaysia, aged 18-80 years, were analyzed. Dietary habits were measured using the Nutrition subscale of Health Promoting Lifestyle Profile II. Results: Education and income were significantly associated with dietary habits before and after controlling for demographics. There was a gradient of association; a higher level of education and higher income were associated with better dietary habits. However, only education remained significantly associated with dietary habits when the other two socioeconomic variables were included. Employment was not significantly associated with dietary habits before or after controlling for demographic variables and the other two sociodemographic variables. Conclusions: This study showed that education is the strongest predictor of healthy diet, and a social gradient in dietary habits still exists even among health-conscious population.

Religiosity, dietary habit, intake of fruit and vegetable, and vegetarian status among Seventh-Day Adventists in West Malaysia.

Religion has been shown to be salutary on health, and a possible link between religion and positive health outcomes is diet. Research has shown that religiosity is associated with better diet but most studies were conducted in a multi-denominational context, which might be confounded with theological differences. This study examined the relationship between religiosity and diet within a homogenous group of believers. Data from survey of 574 Seventh-Day Adventists residing in West Malaysia, aged 18-80, were analyzed using multiple regressions. While none of the religious variables were significantly associated with fruit and vegetable intake, a higher level of religiosity was associated with a better dietary habit and vegetarian status. The mixed relationship between religiosity and diet suggest that further research is needed to explore how religion might influence the diet of adherents.

Advancing the science of dissemination and implementation in behavioral medicine: evidence and progress.

The enormous time lag between the discovery of new knowledge and its implementation poses a significant challenge to improving public health because of the very slow uptake into policy and practice. The field of dissemination and implementation research in behavioral medicine is receiving increased attention because of the keen interest in accelerating knowledge transfer from relevant research to improve the health and wellbeing of populations in many different settings, contexts, and countries around the world. This is particularly important in high-risk populations, resource-poor and developing regions of the world where the difference in health systems, languages, and cultures very significantly influences the translation of evidence into policy and practice. Moreover, demonstrating the broader societal and economic value of behavioral interventions in settings where they are implemented can further support the sustainability, uptake, and implementation of these findings in other settings and contexts. This special issue presents a series of empirical studies, reviews, and case studies that address dissemination, implementation, and translation issues in both developed and developing countries. Specifically, the learnings from the application of many and varied theories and research methodologies are very relevant for bridging the current division between research findings and their translation and uptake into policy and practice.

Religiosity and spirituality and the intake of fruit, vegetable, and fat: a systematic review.

Objectives. To systematically review articles investigating the relationship between religion and spirituality (R/S) and fruit, vegetable, and fat intake. Methods. PubMed, CINAHL, and PsycInfo were searched for studies published in English prior to March 2013. The studies were divided into two categories: denominational studies and degree of R/S studies. The degree of R/S studies was further analyzed to (1) determine the categories of R/S measures and their relationship with fruit, vegetable, and fat intake, (2) evaluate the quality of the R/S measures and the research design, and (3) determine the categories of reported relationship. Results. Thirty-nine studies were identified. There were 14 denominational studies and 21 degree of R/S studies, and 4 studies were a combination of both. Only 20% of the studies reported validity and 52% reported reliability of the R/S measures used. All studies were cross-sectional, and only one attempted mediation analysis. Most studies showed a positive association with fruit and vegetable intake and a mixed association with fat intake. Conclusion. The positive association between R/S and fruit and vegetable intake may be one possible link between R/S and positive health outcome. However, the association with fat intake was mixed, and recommendations for future research are made.

Promoting physical activity with goal-oriented mental imagery: a randomized controlled trial.

Self-regulation theory and research suggests that different types of mental imagery can promote goal-directed behaviors. The present study was designed to compare the efficacy of approach imagery (attainment of desired goal states) and process imagery (steps for enacting behavior) in promoting physical activity among inactive individuals. A randomized controlled trial was conducted with 182 inactive adults who received one of four interventions for generating mental images related to physical activity over a 4-week period, with Approach Imagery (approach versus neutral) and Process Imagery (process versus no process) as the intervention strategies. Participants received imagery training and practiced daily. Repeated measures ANOVAs revealed that Approach Imagery: (1) increased approach motivations for physical activity at Week 4; (2) induced greater intentions post-session, which subsequently induced more action planning at Week 4; (3) enhanced action planning when combined with process images at post-session and Week 1; and (4) facilitated more physical activity at Week 4 via action planning. These findings suggest that inducing approach orientation via mental imagery may be a convenient and low-cost technique to promote physical activity among inactive individuals.

Randomised-controlled trial of a web-based dietary intervention for patients with type 2 diabetes mellitus: study protocol of myDIDeA.

BACKGROUND: The potential of web-based interventions in dietary behaviour modification of the diabetics has not been fully explored. We describe the protocol of a 12-month match-design randomised controlled trial of a web-based dietary intervention for type 2 diabetic patients with primary aim to evaluate the effect of the intervention on their dietary knowledge, attitude and behaviour (KAB). The secondary objective of this study is to improve the participants' dietary practices, physical measurements and biomarkers. METHODS/DESIGN: A minimum total sample of 82 Type 2 diabetics will be randomised, either to the control group, who will receive the standard diabetes care or the e-intervention group, who will participate in a 6-month web-based dietary intervention in addition to the standard care. The dietary recommendations are based on existing guidelines, but personalised according to the patients' Stages of Change (SOC). The participants will be followed up for 6 months post-intervention with data collection scheduled at baseline, 6-month and 12-month. DISCUSSION: We are aiming for a net improvement in the KAB score in participants of the e-intervention group, besides investigating the impact of the e-intervention on the dietary practices, physical measurements and blood biomarkers of those patients. The successful outcome of this study can be a precursor for policy makers to initiate more rigorous promotion of such web-based programmes in the country. TRIAL REGISTRATION: Clinicaltrials.gov NCT01246687.